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Many Physicians View Treatment Guidelines Positively

News Release
Jan. 30, 2003

FURTHER INFORMATION, CONTACT:
Alwyn Cassil: (202) 264-3484

ASHINGTON, D.C.—Sometimes dismissed as "cookie-cutter" medicine, treatment guidelines for specific medical conditions influenced more than half of all U.S. physicians in 2001, and nearly two-thirds of affected physicians viewed guidelines positively, according to a national study released today by the HSC.

The study found similar positive results for patient satisfaction surveys and practice profiling, where individual physicians’ treatment patterns and use of medical resources are compared with other physicians.

In 2001, 62 percent of physicians said patient satisfaction surveys had a moderate, large or very large effect on their practice of medicine, with 77 percent of affected physicians rating the use of patient surveys positively. Practice profiling was less widespread—only 34 percent of physicians reported profiling affected their practice of medicine, and half of those affected reported a positive effect.

"With medicine rapidly changing and increasingly complex, care management tools—such as treatment guidelines—offer the potential to help physicians practice more effectively, so it’s encouraging that most physicians view these tools positively," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

The study’s findings are detailed in an HSC Issue Brief—Physicians and Care Management: More Acceptance Than You Think—available here. The study is based on results from HSC’s Community Tracking Study Physician Survey, a nationally representative survey involving about 12,000 practicing physicians.

The study also found that physicians in practices with more revenue from managed care were somewhat more likely to report that care management tools had affected their practice of medicine, but managed care participation had little effect on whether physicians viewed the tools positively.

Researchers did find that physicians who completed their medical training within the five years prior to the survey were more likely to report that care management tools both influenced their practice and had a positive effect than physicians who completed their training earlier.

"Newer physicians may be more familiar and comfortable with evidence-based medicine and the use of care management tools because they were trained in the era of managed care," said HSC Health Research Analyst Marie Reed, M.H.S, who co-authored the study with HSC Researcher Kelly Devers, Ph.D., and Bruce Landon, M.D., of Harvard Medical School.

The study also examined the use of financial incentives tied to practice profiling and patient satisfaction surveys. Physicians who received financial incentives based on profiling were more than twice as likely to indicate that profiling affected their practice of medicine than physicians without such incentives—62 percent vs. 30 percent.

Similarly, 84 percent of physicians receiving financial incentives tied to patient satisfaction surveys indicated the surveys affected their practice of medicine, compared with 59 percent of physicians without such incentives.

However, physicians’ positive assessments of care management tools were not strongly linked to the use of financial incentives, suggesting that other factors such as perceived fairness may be more important.

For example, the use of risk adjustment to reflect the greater need for services by patients in poorer health made a large difference in physicians’ acceptance of practice profiling. Nearly two-thirds (64%) of physicians with financial incentives tied to risk-adjusted profiling reported a positive effect, compared with 46 percent of physicians with a financial incentive whose profiles were not risk adjusted.

"If care management tools are going to improve the quality of care, physicians must perceive them as valid, useful and fair," Reed said.

Stakeholder Comments on the HSC Study

Yank D. Coble Jr., M.D., president, American Medical Association, www.ama-assn.org
"It is not surprising to us that physicians would embrace evidence-based, clinical guidelines developed by physicians to improve quality. For more than a decade, the AMA has convened physician experts-not bureaucrats or bean counters-to shape science-based measurement tools to improve medical quality not to control or ’manage’ costs. These guidelines must be patient focused and allow for the unique circumstances of each individual. Medicine is a science, but it is also an art."

Karen Ignagni, president, American Association of Health Plans, www.aahp.org
"Today’s findings-that physicians increasingly rely on practice guidelines, and that our community is playing an important role in that development-demonstrate that doctors and health plans can work together to promote broader use of treatments that are safe and effective for patients."

Helen Darling, president, Washington Business Group on Health, www.wbgh.org
"This is a very exciting study, providing considerable evidence that physicians understand and appreciate that treatment guidelines can enhance their practice and increase opportunities for them to use their training to sort out complex issues and provide added value to clinical practice. There is also clearly a ’generational’ difference that will eventually make commonplace the use of newer tools, evidence-based guidelines, and reliance on digital technology. This study makes me much more optimistic that there are some very important positive changes ahead in health care delivery. Given what is happening with health care costs, it is nice to have some good news."

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely insights on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded exclusively by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.

 

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